Health Equity Barriers to Accessing Vaccination and Screening Services in Low- and Middle-Income Countries: A Narrative Review.

Abstract

Vaccination and screening services are essential components of preventive care, yet access to these services remains unequal in many low- and middle-income countries (LMICs). This narrative review examines health equity barriers affecting access to vaccination and screening services in LMICs, with screening evidence drawn predominantly from cervical cancer/HPV-related programs and selected other preventive screening contexts, and identifies strategies to improve equity in preventive care. Relevant English-language literature was identified through PubMed and Scopus and synthesized thematically. The review examined cross-cutting equity barriers across vaccination and the screening contexts represented in this evidence base. Barriers operated across individual and household, community and sociocultural, health system, and policy and structural domains. Common barriers included poverty, transportation costs, low health literacy, stigma, weak primary care, workforce shortages, and inadequate financing. Vaccination-specific challenges included weak cold-chain systems, reliance on campaign-based delivery, vaccine hesitancy, and missed immunization schedules, whereas screening-specific challenges included repeated visits, weak referral and follow-up systems, stigma related to cancer and reproductive health screening, and delayed diagnosis. These barriers disproportionately affected rural populations, low-income households, women and girls, migrants, ethnic minorities, people with disabilities, and other marginalized groups, contributing to persistent inequities by income, gender, education, and rural-urban residence. Advancing equity in preventive care requires strengthening primary health care, reducing financial and geographic barriers, improving culturally responsive communication, using disaggregated data for equity-focused planning, and investing in workforce and service delivery improvements.